How long will you live?

[sleigh]

For the health care debate:   It seems to me that the single statistic that might best indicate the level of health care and the quality of life in a country is "life expectancy at birth."  And the USA does not stack up well there, according to the CIA's statistics.  The average life expectancy in the US, according to the site, is 78.11 years.  That places the USA at #50 in the world.  Albania dogs our heels at #51 (77.96 years).  At the bottom is Swaziland in southern Africa (#224) with a life expectancy of only 31.88 years -- not a good place to live, if you intend to hit old age.

Who's ahead of us?  Well, lots of countries, including many with that dreaded public health care...  The United Kingdom has a public health care system, and they're ranked #36, with a life expectancy of 79.01 years.  Germany has a public health care system, and it's ranked #32, with a 79.26 year life expectancy at birth.  The PACs for the private insurance and health care industries here in the US have been running ads for the last six months raving about the terrible and inhumane horrors of the Canadian system... but Canada is ranked #8 in life expectancy, with an average of 81.32 years.

Hmm....

Who's #1?  Macau (a special administrative region of the People's Republic of China, with free public health care), at 84.36, followed by #2 Andorra (in Europe, bordered by Spain and France -- and yes, all Andorrans are entitled to public health care) at 82.51 and #3 Japan at 82.12....  Oh, Japan has a universal health care system too, and pays half as much as the USA for health care.

Yes, I know that life expectancy is not only way to look at the quality of health care in a country and there are other factors at work here, but it's a good bottom line measure.  What this indicates to me is that universal health care can be done, and done well.  We need to figure out how we can do it, and do it even better than other countries.

Comments

[spaceoperadiva.livejournal.com]

At first I was going to argue that you have to discard special populations like Macau and Andorra from these calculations because genetics play such a strong role in life expectancy in some areas. There are pockets in the Caucuses, for example, where life expectancy is over 100 but they have pretty terrible living conditions and bad infant mortality rates. There's something in the gene pool there (and I think in certain pockets in Japan) that makes people in the region long-lived. I looked up Macau and Andorra, though, and they both do much better than the US in the area of infant mortality. Cuba does better in infant mortality than we do. I think that's really embarrassing, considering all the other problems Cuba has that we don't.

Anyhow, I think if you look at life expectancy and infant mortality in tandem, you get a pretty good idea of what's going on with living conditions and the health care system. We drag at the bottom of the First World pack by these measures.

Wingnuts will try to discard the infant mortality stats for the US based on the notion that because we intervene in a lot of premature births, these deaths count against us in ways they wouldn't in other countries. I rudely call these people wingnuts because they never have any statistics or other data to back up this claim. Also, places with better infant mortality and better health care have lower rates of premature birth to begin with, a notion that *is* supported by the data. So if we're not breaking even with all our supposedly miraculous abilities to save preemies that aren't being saved elsewhere while simultaneously being penalized for losing some that wouldn't be counted as live births elsewhere, we're still getting it wrong.

I think the data very much shows that public health care preserves life all along the age spectrum. Public health care is Pro Life! :P

[daedala.livejournal.com]

This graph directly compares length of life with per-capita spending on healthcare. (http://ucatlas.ucsc.edu/health/spend/cost_longlife75.gif) It's a little old, but I'm pretty sure the point holds.

I find it instructive.

I know that people say "there are other measures than length of life!" and so on, but just what is that extra value we are getting? Where are the studies that say that quality of health here is so much better than Japan and Andorra and Macau and so on? Yes, the rich can buy more care here -- but they can elsewhere too.

[cathshaffer.livejournal.com]

One problem I find with this correlation is that the top killers in the US are western lifestyle diseases for which medicine has no cure. It doesn't matter how high quality your health care is or how good your access if you are 100 pounds overweight, your arteries are clogged, your blood pressure is high, and you don't make lifestyle changes. It would be more instructive to look at diseases that are preventable or treatable with medicine.

[sethb.livejournal.com]

The statistics have nothing to do with intervening in premature births, but in defining live births.

CDC Division of International Health says:
Significant differences exist between infant mortality rates published by the Central Asian countries and the rates derived from several USAID-supported surveys, primarily due to differences between the definition of live birth used in the Central Asian countries and the WHO definition. WHO considers a live birth any child that breathes or shows any other sign of life after separation from the mother, irrespective of the duration of pregnancy. According to the definition of live birth currently used in Kazakhstan and other Central Asian countries, a pregnancy that terminates at less than 28 weeks of gestation is considered premature and classified as a late miscarriage even if signs of life are present at the time of delivery. Accordingly, some events classified as late miscarriages in the official registration system would be classified as live births and early infant deaths according to the WHO definition. Also, significant underreporting of cases of infant death takes place in the official registration system.

Transition Newsletter, World Bank says:
Failing to use the WHO definition of live birth.
A baby’s death may go unrecorded because the baby was never officially alive. The WHO definition says an infant is alive if it exhibits any signs of life. The Soviet era-definition—still dominant in several CIS countries-uses breathing as the sole indicator of life. Under the Soviet definition, moreover, infants who are born before 28 weeks of gestation, who weigh less than 1,000 grams, or who are less than 35 centimeters long are not considered live births unless they survive for seven days.

There could also be a Simpson's Paradox effect at work.

[cathshaffer.livejournal.com]

No, actually medical science sucks at treating these diseases through "education." Education is almost a total failure at treating obesity. Ninety percent of all diets fail. And obesity is the key to metabolic syndrome and its associated morbidity and mortality.

[cathshaffer.livejournal.com]

That's interesting. Another confounder is that assisted reproductive technologies are increasing the incidence of prematurity and multiple gestation in western countries. The rate of twin births has increased from one percent to three percent of births, which means two out of every three multiple pregnancies is caused by the use of fertility drugs. When you consider that often the reason fertility drugs are needed is because of advanced maternal age or underlying health problems, you can see that to some extent an increased rate of premature birth is also a result of our prosperity.

I am not saying that the US health system couldn't use some improvement. I just don't think you can say, "Here is my argument. I know it is fundamentally flawed, but don't you agree with my conclusion?"

[cathshaffer.livejournal.com]

Also, I don't know how my comment got threaded under the above. That wasn't here when I left the comment, as far as I know. This particular template can be kind of confusing. :-)

[sethb.livejournal.com]

If the US health system couldn't be improved, it would be the first human construction about which that could be truthfully said.

Trying to figure out the ideal system (for the US) gets interesting. Magic isn't allowed; everything has costs. I think that something like "everyone gets (free) medicine equivalent to what a middle-class well-insured person could get and afford 40 years ago, and more modern stuff if it's cheaper and better" would be a good start.

[minnehaha.livejournal.com]

The never-stated problem with all of these arguments is that they won't convince the racists. The United States is basically two different countries living in the same geographical area: a middle-class white country, and a poor black country. People will read your statistics and think "that's because of all those poor blacks," and not worry about it. This sucks, but I think it's one of the major unstated issues in the healthcare debate.

B